Reducing Opiate Use in Children and Teens: A Strategic Approach to a National Challenge


Anna Grosz, MD

Abstracts from the Kaiser Permanente 2019 National Quality Conference

From Colorado, Georgia, Hawaii, Mid-Atlantic States, Northern California, Northwest, Southern California, Washington, Program Office

Background: Opiate overuse and abuse is a national concern. One area that has received little attention is in pediatrics, even though many opiate addictions start in childhood or teenage years. Opiate addiction often starts in adolescence from a physician’s prescription. Additionally, codeine is known to increase risk of respiratory depression and death in children, especially after a tonsillectomy. Patient safety, particularly that of our youngest and most vulnerable patients, was the critical driver of this project.
Methods: Starting in Kaiser Permanente (KP) Northwest (KPNW) and spreading to all other KP Regions, electronic health record tools and opioid-reduction protocols were shared with head and neck surgery and other leaders in other Regions and with KPNW surgical services, pediatrics, and pharmacy committees. Electronic health record tools included order sets, smart groups, restriction locators, alternative alerts and patient instructions. Champions were identified, and leaders were engaged to spread this work throughout KP Regions. Pediatric opioid use has been measured from 2012 to 2018 with ongoing modification of protocols to further reduce usage.
Results: Starting with KPNW in 2012 and expanding to include KP Colorado, KP Hawaii, KP Northern California, and KP Southern California, there has been an overall 6-fold reduction in opioid use in young children after tonsillectomies through 2017. Opioid prescriptions for children younger than age 7 undergoing tonsillectomies dropped from an average of 72% to 13%. Post-tonsillectomy opiate use in young children went from 79% to 9% in KPNW; 88% to 7% in KP Colorado; 83% to 2% in KP Hawaii; 80% to 21% in KP Northern California; and 64% to 4% in KP Southern California. Additionally, several Regions have achieved meaningful reductions in overall pediatric opiate use stemming from interregional collaboration. KP Washington, KP Mid-Atlantic States, and KP Georgia have now joined this work.
Discussion: Keys to successful spread include starting with a passionate leader, identifying regional champions, using strategic interpersonal alliances, and using data to drive change. It is also important to identify and address barriers and resistance to change as well as a plan to maintain success. This interactive seminar will provide tools to drive change, receptivity, and appreciation of the new protocols; audience participation through guided-reflective inquiries and scenarios; small group discussion about related change management initiatives; and audience question and answer sessions.

Abstracts from the Kaiser Permanente 2019 National Quality Conference


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